7. PROJECT SUMMARY Opioid use disorder (OUD) is a problem of national concern. Medication-based treatment (MT) reduces opioid use, associated risk behaviors and death. Despite evidence supporting MT with buprenorphine, in more than of US counties (mainly rural), there are no prescribers. Patients travel long distances, join waitlists, or go without MT. Other barriers to care include lack of transportation, competing demands (work, childcare) and stigma. Combined, lack of access and barriers leaves millions without treatment. Our innovative solution (Boulder) is a telehealth-based treatment solution offering long-term support for OUD. Our vision is to deploy care teams (Prescribing Clinician, Nurse Coach, Care Advocate and Certified Peer Coach for each patient) to deliver a comprehensive array of services, supervised by addiction specialists with decades of experience. Technology enables us to effectively scale a program that meets all of NIDA's guidelines for appropriate oversight, and provides low-barrier, patient-centered interventions (e.g. video medication monitoring and private (at home) random observed saliva drug testing. The long-term goal of this proposal is to build a scalable solution able to reach patients who are unable to access evidence-based treatment. Our digital program promises to dramatically improve the patient experience, boosting patient retention, satisfaction, medication adherence, and functional outcomes by providing low barrier, quality care. The patient-facing product is developed. In preliminary testing, patients reported high satisfaction, engagement, and usability, and access to care was increased by 38% in three months. The overall objective is to evaluate the ability of a virtual platform to create the necessary paradigmatic shift in OUD treatment. To achieve this objective, we propose the following aims: Phase I, Aim I: Advance Boulder's mobile platform development and obtain patient feedback; Phase II, Aim II: Determine Boulder's impact on patient engagement, program retention, access to care, and care continuity; and Phase II, Aim III: Determine Boulder's impact on opioid use and patient functional status. Purchasers of our product (e.g. private/commercial/governmental payors, at-risk provider groups, etc.) who provide remuneration on a per-patient, per-month basis, realizing substantial cost savings through our integrated services. Unlike typical fee-for-service care delivery, our economic model aligns incentives around delivering superior patient outcomes. The virtual OUD treatment product's end-users are resource-constrained patients who will access care no cost to them. Technology enables our team of medical, behavioral, and social service providers to bring comprehensive telehealth-based care for the longitudinal management of addictive disease directly to the patient, rather than bringing the patient to the care. The research team includes staff and affiliates of Boulder, the Addiction Research and Education Foundation and community partners. Boulder's current investors provide a wide range of support services to ensure success through a national network of experienced entrepreneurs and leaders that provide mentorship and guidance.